手术治疗胃癌肝转移的预后分析

目的：探讨手术治疗胃癌肝转移的预后因素．方法：对25例患者临床病理特征及生存应用多元分析其与预后的关系。结果：20例行同时性肝切除，5例行异时性肝切除，1、3、5年生存率分别为84．0％，28．0％，21．0％。肝转移灶数目（孤立和多灶），转移灶分布（单叶和多叶），肝切除方式，原发灶组织学类型，淋巴结转移及脉管瘤栓与预后相关，多元分析显示多灶肝转移，原发灶淋巴结转移、脉管瘤栓是其预后独立危险因素。结论：对出现孤立转移灶、原发灶无淋巴结转移且无脉管瘤栓的胃癌肝转移患者应手术切除以获得更好的预后。     

胃癌合并肝转移的手术治疗体会

在胃癌根治手术过程中,常发现有其他脏器转移的病例,如肝脏、横结肠、胰腺等。吴孟超报告467例肝癌切除病例,其中消化系统转移性肝癌约占30～50％;Nims报告尸检统计胃癌发生肝转移者占44.5％。过去对胃癌术中同时发现的肝脏转移癌灶,一律视为手术禁忌,然近年来国内外有不少文献报道,在行胃癌根治术的同时一并切除     

40例青年人胃癌临床病理及预后

本文报告40例≤35岁青年人胃癌,其中≤30岁26例,最小年龄21岁,占同期胃癌3.79％。与对照组(≥50岁胃癌组)相比有明显不同点:女性多见,男:女为1:1.9;遗传倾向明显,胃癌家属史阳性(8例,20％)与对照组相比有非常显著性差异,与血型A关系较密切;组织学类型以未分化癌或弥漫性胃癌占优势;预后差,一年内死亡19例,五年生存率5.6％。     

胃癌根治术后肝转移的预后分析

目的 探讨影响胃癌根治术后肝转移患者预后的相关因素。方法 收集2002年1月至2012年1月47例胃癌根治术后肝转移患者的临床资料,采用Kaplan-Meier法行单因素生存分析,Cox比例风险模型对影响预后的因素行多因素分析。结果47例胃癌根治术后肝转移患者的中位生存期为26.0个月,1、2、3、5年生存率分别为87.5％、57.5％、22.5％和6.4％;单因素分析显示年龄、性别、胃癌术后分期、肝内转移灶数目、肝转移灶最大直径、肝外转移灶数目、肝转移治疗方式、手术至肝转移的时间和化疗情况对生存期有影响;Cox多因素分析显示,性别、年龄、胃癌术后分期、肝转移灶最大直径和肝转移治疗方式为影响生存期的独立因素。结论 老年、女性、胃癌术后分期较晚及肝转移灶直径较大者预后不良,采用局部治疗联合全身化疗可延长患者生存期。     

胃癌肝转移的临床特点及治疗

胃癌可通过血行转移、淋巴转移、原发性肿瘤的浆膜侵犯扩散到肝脏.胃癌肝转移的发生率仅次于腹膜转移,是胃癌远处转移的主要部位之一,是主要的肿瘤相关死亡原因,目前其治疗方案仍存较大争议.胃癌肝转移患者的最佳综合治疗策略应建立在患者的临床病理学特征基础之上,利用已有的循证医学证据,通过多学科讨论制定个体化方案.在更多的前瞻性研究结果发布之前,应采取以全身治疗为主的综合治疗,并慎重选择合适病例进行手术切除.     

胃癌肝转移治疗研究进展

胃癌肝转移（gastric cancer with liver metastases,GCLM）是胃癌进展到晚期发生的不良事件,亦是胃癌治疗失败的重要原因之一,难以达到根治目的,目前临床上始终无法给出规范的治疗策略.现普遍认为GCLM的治疗应该把提高病人生存,延长生命作为主要目的.治疗成功与否的关键是严格把握适应症,根据不同病人的具体情况选择合理的治疗方案,单一的治疗方法都难以得到良好的疗效.临床上采取联合治疗的方式,通过多学科综合治疗提高病人的生存率成为可能.     

胃癌肝转移的特点及外科治疗

本文总结了我科1962～1981年间手术治行胃癌736例中肝转移者46例(6.3％)。胃癌肝转移与性别无关。年龄在50～69岁间者居多。Borr Ⅰ、Ⅱ型多、高分化腺癌明显为多。治疗上应根据病人全身状态、胃癌扩散程度和肝转移程度,采取不同治疗方法。     

胃癌伴肝转移的手术治疗（附36例分析）

本文报道了手术治疗经病理证实的36例胃癌伴肝转移的观察结果,分析提示胃癌即使发生了肝转移也不要轻易放弃手术,在姑息性切除的同时处理肝转移灶,再配合其它综合措施,同样能起到缓解症状,提高病人生活质量延长生存期的作用。对原发性肝癌的治疗手段同样适用于转移性肝癌。     

胃癌肝转移患者预后影响因素分析

摘 要：［目的］ 探讨影响胃癌肝转移患者的预后因素。［方法］ 回顾性分析收治的82例胃癌肝转移患者的临床病理资料,对患者的生存时间进行随访,计算患者的1、2年生存率,及中位生存时间（median survival time,MST）。采用Log-rank检验及Cox比例风险模型对可能影响胃癌肝转移患者生存的影响因素进行单因素及多因素分析。［结果］ 82例胃癌肝转移患者1、2年生存率分别为46.3%、13.4%,MST为10.9个月。单因素分析结果显示,病理类型、分化程度、肝转移灶数目、化疗、介入治疗、甲胎蛋白（α-fetoprotein,AFP）与胃癌肝转移患者的预后相关;多因素分析结果显示,病理类型（HR=0.470,95%CI：0.256～0.861,P=0.015）、肝转移灶数目（HR=0.413,95%CI：0.233～0.732,P=0.002）是影响胃癌肝转移患者预后的独立危险因素,化疗（HR=2.193,95%CI：1.354～3.551,P=0.001）是胃癌肝转移患者的独立保护因素。［结论］胃癌肝转移患者预后较差,尤其是病理恶性程度较高及肝转移数目较多的患者,化疗可改善患者的预后。     

胃癌肝转移的治疗策略

胃癌肝转移预后差,临床上虽然有多种治疗方法可供选择,但5年生存率仍不足10%。少部分经过严格筛选的患者,在根治切除原发灶的基础上,行肝转移灶的切除有可能获得较长生存期。多数患者应以全身化疗为主,尽管胃癌的化疗近年有了显著的进展,但其疗效难以长时间维持。分子靶向药物联合化疗是近年的研究热点。其他的治疗手段如射频消融、肝动脉灌注化疗亦有一定的姑息治疗价值。本文综述了胃癌肝转移的治疗进展。     

300例结直肠癌肝转移患者的临床预后分析

目的 探讨结直肠癌肝转移患者的临床特征及预后因素.方法 对300例结直肠癌首发肝转移患者的临床特征及肝转移后的生存情况进行回顾性分析.结果 300例患者中,原发病灶位于结肠者152例,位于直肠者148例.原发肿瘤为管状腺癌272例,黏液腺癌18例,类癌5例,印戒细胞癌4例,鳞癌1例.原发肿瘤为高分化19例,中分化217例,低分化27例.无区域淋巴结转移104例,有区域淋巴结转移162例.原发肿瘤分期为Ⅰ、Ⅱ期62例,Ⅲ、Ⅳ期为237例.同时性肝转移206例,异时性肝转移94例.肝转移灶为单发48例,多发252例.肝转移灶最大直经≤5 cm249例,>5 cm 51例.300例患者转移后中位生存期为19.0个月,肝转移后1、2和5年生存率分别为79.0%、29.0%和3.0%.单因素分析结果显示,患者KPS评分、组织学分级、原发肿瘤T分期、有无区域淋巴结转移、原发肿瘤分期、有无脉管瘤栓、肝转移灶部位、肝转移灶最大直径、肝转移灶数目、同时合并其他转移均与预后有关.多因素分析结果显示,KPS评分、脉管瘤栓、肝转移灶数目、肝转移灶最大直径是结直肠癌肝转移患者预后的独立影响因素.结论 KPS评分、脉管瘤栓、肝转移灶数目和最大直径是结直肠癌肝转移患者预后的影响因素,KPS评分越高、无脉管瘤栓、肝转移灶数目越少、转移灶最大直径越小的患者预后越好.     

乳腺癌肝转移的临床病程与预后分析

目的 探讨乳腺癌肝转移的临床病程、治疗效果及预后因素。方法 采用SPSS 11.5统计软件对152例乳腺癌肝转移患者的生存及预后因素进行回顾性分析。结果 全组中位无病生存期（DFS）为21个月,转移后中位生存期（MSR）为16个月,中位至疾病进展时间（TTP）为7．4个月。肝转移后一线化疗的有效率为54．5％,高于介入治疗（37．7％,P=0．039）。含紫杉类方案化疗组的有效率为63．3％,高于不含紫杉类方案化疗组（40．O％,P=0．04）;含紫杉类方案化疗组的TTP为10个月,亦高于不含紫杉类方案化疗组（7个月,P=0．048）。无论介入治疗（TACE）,还是化疗,治疗有效者的MSR（18个月）均长于无效者（14个月,P=0．002）。对于单发肝转移瘤患者,单纯介入治疗的MSR（30个月）长于单纯化疗（16个月,P=0．0052）;对于多发肝转移瘤患者,单纯介入治疗与单纯化疗的MSR差异无统计学意义。原发肿瘤大小、腋窝淋巴结转移数、雌激素受体状态、肝转移后转氨酶异常程度、肝转移灶大小是影响预后的重要因素。结论 有效的化疗（尤其是含紫杉类方案化疗）和介入治疗能明显改善乳腺癌肝转移患者的预后。     

结直肠癌肝转移患者预后的多因素分析

背景与目的:影响结直肠癌肝转移预后的因素仍未明确,本文旨在探讨影响结直肠癌肝转移预后的相关临床病理因素。方法:选择中山大学肿瘤防治中心1996年1月至2000年12月收治的197例结直肠癌肝转移患者,分析临床病理因素与预后的关系。根据Cox回归模型的结果计算预后指数(prognosticindex,PI),并根据PI值将患者分为不同的危险组,比较各组的生存率。结果:全组总的1、3、5年生存率分别为59.04%、17.73%、11.48%。单因素分析显示,有无肝外病变、原发灶切除、肝转移瘤切除、肿瘤大体类型、血清CEA水平、肝转移瘤数目、大小、分布与结直肠癌肝转移的预后有关;多因素分析显示,肝转移瘤切除、血清CEA水平、肝转移瘤数目和大小与预后有关。根据PI值将患者分为高危组、中危组和低危组,3组的生存率两两间存在显著性差异(P<0.05)。结论:肝转移瘤切除、血清CEA水平、肝转移瘤数目和大小是影响结直肠癌肝转移预后的的重要因素,对于可行肝转移灶切除的患者应积极手术治疗,以提高患者的生存率;PI值可用于结直肠癌肝转移患者的预后估计。     

Advanced gastric cancer with liver metastases successfully treated with S-1

 S-1 is an anticancer drug in which tegafur is combined with modulators, gimeracil and oteracil potassium. We encountered a patient with gastric cancer for whom oral administration of S-1 was effective, and we report this case. A 79-year-old woman visited our hospital with a major complaint of anorexia. Tests revealed severe anemia, with a hemoglobin (Hb) level of 6.5 g/dl, and the patient was admitted to the hospital for treatment. The primary lesion was a large type-1 gastric cancer (poorly differentiated adenocarcinoma) in the middle gastric body. In addition, a lesion with a diameter of 50 mm was observed in the left hepatic lobe and small metastatic lesions were also scattered in the right lobe. When a performance status (PS) of 0 was obtained after her systemic condition had been improved, S-1 was started, at a dose of 80 mg/day (with one course consisting of administration for 4 weeks, followed by 2 weeks' rest). No severe adverse drug reaction was observed. After one course of administration was completed, the patient received administrations at the outpatient clinic. Upon the completion of two courses, computed tomography (CT) showed disappearance of the metastatic lesions and marked regression of the primary lesion. At present, upon completion of the sixth course, no hepatic metastasis is observed and the primary gastric lesion shows a tendency to regress. Her PS is maintained at 0. Received: October 24, 2001 / Accepted: May 29, 2002 Correspondence to:S. Watanabe     

Hepatic resection for synchronous hepatic metastasis from gastric cancer

Background

The role of surgical resection for synchronous hepatic metastases arising from gastric adenocarcinoma has not been established. This study was designed to explore the clinicopathologic features and surgical results of these patients.

Methods

Twenty-five (4.8%) of 526 patients diagnosed with synchronous hepatic metastatic gastric cancer received hepatectomy and gastrectomy at the same time; 2 cases underwent repeat hepatectomy after intrahepatic recurrence. Clinicopathologic parameters of the hepatic metastases and the surgical results for all 25 patients were analysed.

Results

The 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival (RFS) rates after resection were 96.0%, 70.4%, and 29.4%, respectively, and 56.0%, 22.3%, and 11.1%, respectively. Five patients survived for more than 5 years after surgery, and no mortality has occurred within 30 days after resection. Univariate analysis revealed that patients with multiple hepatic metastases suffered poorer OS (P = 0.026) and RFS (P = 0.035) than those with solitary hepatic metastasis. Postoperative adjuvant chemotherapy was a significant indicator of a favourable OS (P = 0.022). Number of metastatic lesions remained significant in the multivariate analysis of OS and RFS (P = 0.039, P = 0.049, respectively). None of variables of the primary lesion was a significant prognostic factor for those patients.

Conclusions

Gastric cancer patients with a solitary synchronous liver metastasis may be good candidates for hepatic resection. Postoperative adjuvant chemotherapy may provide a benefit by aiding in OS.     

A patient with gastric cancer and liver metastases successfully treated with combination chemotherapy including S-1

We report the case of a 62-year-old man with advanced gastric cancer and multiple liver metastases who was successfully treated with combined chemotherapy including S-1. The patient was clinically diagnosed with stage IV (T3 N2 H1 P0) disease and was initially treated with 100 mg/body per day S-1 administered orally for 21 days and 10 mg/body per day cisplatin (CDDP) infused on days 1–5, 8–12, and 15–19. This chemotherapy resulted in significant reduction of the liver and gastric tumors. After receiving additional CDDP/S-1 administration as an outpatient, the patient's liver masses disappeared as shown on abdominal computed tomography (CT). With the patient's desire and informed consent, he underwent curative surgery with total gastrectomy, D1+α lymph node dissection, and partial resection of liver S4. After discharge without any surgical complication, CT revealed regrowth of the S4 liver mass, and combined docetaxel and CDDP was selected as second-line chemotherapy with local radiation therapy against the hepatic metastasis. Additionally, a third regimen with irinotecan and S-1 was given. At 2 years 7 months after the initial treatment, no sign of cancer (including liver metastasis and peritoneal dissemination) has been identified by radiological follow-up examinations.     

胃癌肝转移的综合治疗

胃癌肝转移(gastric cancer with liver metastases,GCLM)是胃癌进展到晚期发生的不良事件,亦是胃癌治疗失败的重要原因,难以达到根治.胃癌肝转移的治疗方法很多,包括外科治疗,内科化疗以及介入射频治疗.各种方法都有其治疗优点和不足之处,通过分析比较,对胃癌肝转移的治疗认识有所提高,但很多治疗观点仍有争论,目前仍无统一的治疗规范,治疗共识有待提高.     

Guidelines for the detection and treatment of liver metastases of colorectal cancer

The spread of the surgical treatment for hepatic metastases have been crucial in the improvement of treatment and survival of metastatic colorectal cancer. The early and accurate diagnosis of metastases and the assessment of their size are essential factors to reach the optimal results with this treatment strategy. The precise indication of the surgical technique with or without the previous administration of neoadjuvant chemotherapy is of significant importance for the choice of R0 surgery and the timing of intervention. Although there is an agreement regarding some parameters related to diagnosis techniques and surgical criteria such as the bilobar extension, the size of the remaining liver post-surgical removal and the indication of pre-operatory chemotherapy, it is necessary to consider all these factors to set up standard criteria and optimize the results. In this article we review all these parameters, from disease follow up to detect metastatic dissemination to the basic criteria for use of neoadjuvant chemotherapy, in order to suggest some general recommendations of evidence level II and recommendation grade A.     

结直肠癌伴肝转移91例患者的多因素预后分析

目的：探讨结直肠癌同时性肝转移患者的预后相关因素。方法：采用多因素回归分析方法回顾性分析了91例结直肠癌同时性肝转移患者的生存因素。结果：91例结直肠癌同时性肝转移的患者中位生存期为16.8个月,1年生存率为61.54%,3年生存率为14.79%,5年生存率为8.87%。单因素分析显示原发灶手术、肝转移分期、介入治疗、放射治疗、物理治疗、化疗和新药使用与患者的生存期显著相关;多因素分析显示,肝转移分期、原发病灶手术切除、介入治疗、物理治疗对患者的预后有显著影响,是结直肠癌同时性肝转移影响预后的主要因素。结论：对于结直肠癌同时性肝转移的患者应积极切除原发病灶,进行介入、物理等综合治疗可以提高患者的生存期。